학술논문
SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus based on the RELESSER prospective cohort.
Document Type
Academic Journal
Author
Rua-Figueroa I; Department of Rheumatology, Hospital Universitario Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain iruafer@gobiernodecanarias.org.; García de Yébenes MJ; Institute for Musculoskeletal Health, Madrid, Spain.; Martinez-Barrio J; Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Galindo Izquierdo M; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain.; Calvo Alén J; Department of Rheumatology, Hospital Sierrallana, Vitoria, Spain.; Fernandez-Nebro A; UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain.; Menor-Almagro R; Department of Rheumatology, Jerez Hospital, Jerez, Spain.; Carmona L; Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain.; Tejera Segura B; Department of Rheumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.; Tomero E; Department of Rheumatology, Hospital Universitario de la Princesa, Instituto de Investigación La Princesa, Madrid, Spain.; Freire-González M; Department of Rheumatology, University Hospital Complex of A Coruña, A Coruña, Spain.; Sangüesa C; Department of Rheumatology, Hospital Germán Trias i Pujol, Barcelona, Spain.; Horcada L; Department of Rheumatology, Hospital de Navarra, Pamplona, Spain.; Blanco R; Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.; Uriarte Itzazelaia E; Donostia Ospitalea, San Sebastian, Spain.; Narváez J; Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain.; Rosas Gómez de Salazar JC; Department of Rheumatology, Marina Baixa Hospital, Alicante, Spain.; Gómez-Sabater S; Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain.; Morales CM; University Hospital Centre León, Leon, Spain.; Andreu JL; Department of Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.; Segarra VT; Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despi, Spain.; Aurrecoechea E; Department of Rheumatology, Hospital Universitario Sierrallana, Torrelavega, Spain.; Perez A; Immune System Diseases and Oncology Service, University Hospital 'Príncipe de Asturias', Alcala de Henares, Spain.; Nóvoa Medina J; Department of Rheumatology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas GC, Spain.; Salgado E; Department of Rheumatology, Complejo Hospitalario de Orense, Ourense, Spain.; Lozano-Rivas N; Department of Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain.; Montilla C; Department of Rheumatology, Hospital Clinico Universitario Salamanca, Salamanca, Spain.; Ruiz-Lucea E; Basurto University Hospital, Bilbao, Spain.; Arevalo M; Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain.; Iñiguez C; University Hospital Lucus Augusti, Lugo, Spain.; García-Villanueva MJ; Hospital Universitario Ramon y Cajal, Madrid, Spain.; Exposito L; Hospital Universitario de Canarias, La Laguna, Spain.; Ibáñez-Barceló M; Department of Rheumatology, Son Llatzer Hospital, Mallorca, Spain.; Bonilla G; Department of Rheumatology, La Paz University Hospital, Madrid, Spain.; Carrión-Barberà I; Department of Rheumatology, Hospital del Mar, Barcelona, Spain.; Erausquin C; Department of Rheumatology, Hospital Universitario Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain.; Fragio Gil JJ; La Fe University and Polytechnic Hospital, Valencia, Spain.; Pecondón A; Miguel Servet University Hospital, Zaragoza, Spain.; Toyos FJ; Department of Rheumatology, Hospital Virgen Macarena, Sevilla, Spain.; Cobo T; Hospital Infanta Sofía, Madrid, Spain.; Muñoz-Jiménez A; Hospital Universitario Virgen del Rocío, Sevilla, Spain.; Oller J; Doctor Peset University Hospital, Valencia, Spain.; Nolla JM; Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain.; Pego-Reigosa JM; Department of Rheumatology, University Hospital Complex of Vigo, Vigo, Spain.
Source
Publisher: BMJ Country of Publication: England NLM ID: 101633705 Publication Model: Electronic Cited Medium: Print ISSN: 2053-8790 (Print) Linking ISSN: 20538790 NLM ISO Abbreviation: Lupus Sci Med Subsets: MEDLINE
Subject
Language
English
ISSN
2053-8790
Abstract
Objective: To develop an improved score for prediction of severe infection in patients with systemic lupus erythematosus (SLE), namely, the SLE Severe Infection Score-Revised (SLESIS-R) and to validate it in a large multicentre lupus cohort.
Methods: We used data from the prospective phase of RELESSER (RELESSER-PROS), the SLE register of the Spanish Society of Rheumatology. A multivariable logistic model was constructed taking into account the variables already forming the SLESIS score, plus all other potential predictors identified in a literature review. Performance was analysed using the C-statistic and the area under the receiver operating characteristic curve (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. ORs were transformed into score items, and the AUROC was used to determine performance.
Results: A total of 1459 patients who had completed 1 year of follow-up were included in the development cohort (mean age, 49±13 years; 90% women). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from four variables: age (years) ≥60, previous SLE-related hospitalisation, previous serious infection and glucocorticoid dose. A score was built from the best model, taking values from 0 to 17. The AUROC was 0.861 (0.777-0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive likelihood ratio of 5.48.
Conclusions: SLESIS-R is an accurate and feasible instrument for predicting infections in patients with SLE. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Methods: We used data from the prospective phase of RELESSER (RELESSER-PROS), the SLE register of the Spanish Society of Rheumatology. A multivariable logistic model was constructed taking into account the variables already forming the SLESIS score, plus all other potential predictors identified in a literature review. Performance was analysed using the C-statistic and the area under the receiver operating characteristic curve (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. ORs were transformed into score items, and the AUROC was used to determine performance.
Results: A total of 1459 patients who had completed 1 year of follow-up were included in the development cohort (mean age, 49±13 years; 90% women). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from four variables: age (years) ≥60, previous SLE-related hospitalisation, previous serious infection and glucocorticoid dose. A score was built from the best model, taking values from 0 to 17. The AUROC was 0.861 (0.777-0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive likelihood ratio of 5.48.
Conclusions: SLESIS-R is an accurate and feasible instrument for predicting infections in patients with SLE. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)